River blindness campaign ends West Africans return to fertile farmlands

Ouagadougou, Burkina Faso, 4 December 2002 -On Friday, December 6, 2002, history will be made. This day officially marks the end of nearly 30 years of work to eliminate river blindness as a public health threat in West Africa. On this day in Ouagadougou, Burkina Faso, officials from the World Health Organization and others will recognize the achievement of thousands of people working together for a greater good.

These people –bankers, fly catchers, pilots, chief executives, community health workers and others –have prevented 600,000 cases of blindness. Their efforts meant that 18 million have grown up free of the threat of river blindness. Because of the people of the Onchocerciasis Control Programme (OCP), thousands of farmers are now moving to reclaim 25 million hectares of fertile river land, enough land to feed 17 million people.

“The accomplishments of this programme inspire all of us in public health to dream big dreams because we can reach ‘impossible’ goals and lighten the burden of millions of the world’s poorest people,” said WHO Director-General Gro Harlem Brundtland, “When critics say that the next proposal is too ambitious, that it will be too expensive, it will take too long, that funds will be wasted, that the job will be too complicated or dangerous – tell these critics to remember this day.”

To fully understand OCP’s accomplishment, it is necessary to recall the devastation river blindness inflicted on West Africa when the programme started in 1974. For centuries, black flies had been injecting parasites into people living near rivers. In hundreds of thousands of infected people, parasites ate away their hosts’ eyesight.

When the campaign began in West Africa, as many as 10% of the population in high impact regions were completely blind and 30% had severe visual handicaps. People in West Africa recognized that something associated with the rivers was causing blindness and farmers began leaving their fields. One study in the early 1970s documented that 250,000 square kilometres of once-productive river valley had been abandoned, which translated into an economic loss of $30 million a year.

A campaign to end this scourge was launched with two goals. First, it would eliminate river blindness as a public health problem in West Africa and an impediment to socioeconomic development. Second, it would ensure that, when the programme ended, the countries in West Africa would be able to continue monitoring for a return of river blindness.

National and community leaders planned and implemented control programmes. The programme initially concentrated on eliminating the vector, the black fly. Aerial spraying of larvicide blanketed an area of 1.3 million square kilometres, in which 30 million people lived. Week after week, helicopter pilots snaked their way over more than 50,000 kilometres of rivers, often flying close to trees and through narrow canyons. On the riverbanks, hundreds of volunteers rolled up their pants legs and exposed themselves to black flies, in order to collect flies and monitor the parasites in the region.

In 1988, the programme added another weapon in the fight when Merck offered its anti-parasite drug ivermectin free of cost. Hundreds of volunteers drove to the end of red dirt roads to hand out slim white pills, year after year, until communities took over the drug distribution part of the programme. And for almost 30 years, donors consistently financed it all.

Now OCP is ending its work. It leaves behind a stronger health infrastructure with expertise built over the last 28 years in vector control, epidemiology and public health management. In place now is a national surveillance capacity which can detect new outbreaks of river blindness, should they occur, and help in other diseases.